Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review

Noar, Seth M.; Francis, Diane B.; Bridges, Christy C.; Sontag, Jennah M.; Brewer, Noel T.; Ribisl, Kurt M.

doi:10.1177/1077699016674188

Cited by 97 publications

(94 citation statements)

References 49 publications

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“…On a theoretical note, our findings provide evidence for the utility of the message impact framework (Noar, Francis, Bridges, Sontag, Brewer, et al, 2016). According to the framework, consumers first orient to the warning, followed by immediate emotional reactions.…”

Section: Discussionmentioning

confidence: 51%

“…Using data from two experiments across two populations allowed us to evaluate the reliability of our competing models. Specifically, we recruited from socioeconomically disadvantaged communities because these populations are at highest risk for tobacco-related conditions (Henley et al, 2016) but are often under-represented in this line of research (Noar, Francis, Bridges, Sontag, Brewer, et al, 2016). …”

Section: Introductionmentioning

confidence: 99%

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Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

Skurka

Byrne

Davydova

et al. 2018

Social Science & Medicine

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Rationale The U.S. courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking’s health effects. However, research in judgment and decision-making suggests these relationships are more complex. Objective In this paper, we drew on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth). Method We tested these competing mediation models using data from two experiments with two populations each—adult smokers (N=313, 238) and primarily non-smoking middle-school youth (N=340, 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern U.S. Results The best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of GWL exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that GWL exposure indirectly promoted adults’ quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of GWL exposure on strengthened risk beliefs among adults and youth. Conclusions These results speak to the importance of negative affect in directly motivating adult smokers’ quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

Skurka

Byrne

Davydova

et al. 2018

Social Science & Medicine

View full text Add to dashboard Cite

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“…A strength of our review is one of multiple observations and replication – i.e., we were able to look across policy changes in multiple countries and studies, and we saw consistency in both the pattern and direction of findings. Another strength of the existing evidence is the demonstration of the pathways through which strengthened warnings may have impact – from large increases in attention and message reactions (Noar, Francis, et al, 2016), to enhanced knowledge and beliefs (current study and our previous meta-analysis; (Noar, Hall, et al, 2016)), and finally to downstream impact on behavior. Changes in smoking behavior may be larger when countries implemented comprehensive tobacco control policies, which is consistent with prior tobacco control policy research (Bonnie et al, 2007; Hopkins et al, 2010; US Department of Health and Human Services, 2014).…”

Section: Discussionmentioning

confidence: 80%

“…We found strengthened warnings were associated with higher knowledge about tobacco quitlines and more calls to quitlines. This is likely because strengthened warnings themselves garner more attention (Noar, Francis, et al, 2016), and also because quitline information tends to be strengthened along with new warnings. Knowledge about the quitlines increased in three countries – Australia (Miller et al, 2011), Mexico (Thrasher et al, 2012), and New Zealand (Wilson, Weerasekera, Hoek, Li, & Edwards, 2010) – after implementation of pictorial warnings.…”

Section: Discussionmentioning

confidence: 99%

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The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies

Noar

Francis

Bridges

et al. 2016

Social Science & Medicine

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275

228

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Objectives Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings. Methods We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior. Results We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies. Conclusions Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.

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Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100

et al. 2021

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IMPORTANCE Starting in 2022, the US Food and Drug Administration (FDA) plans to require all cigarette packages in the US to display graphic health warnings depicting health harms associated with smoking. The FDA originally planned to implement such warnings in 2012, but tobacco industry litigation delayed the effort.OBJECTIVE To assess the estimated population health outcomes associated with a policy requiring graphic health warnings on cigarette packages in the US and with a 10-year delay in implementation. DESIGN, SETTING, AND PARTICIPANTSThis decision analytical model used simulation modeling of smoking prevalence and smoking-attributable mortality in the US from 2012 to 2100, using the Cancer Intervention and Surveillance Modeling Network smoking population model. The study was conducted from October 2020 to July 2021. MAIN OUTCOMES AND MEASURESThe primary outcomes were annual adult smoking prevalence, smoking-attributable deaths averted, and life-years gained vs the baseline scenario. A baseline scenario assuming no graphic health warnings was compared with expected outcomes of implementing graphic health warnings in 2022 vs 2012. Policy effects were considered under varying assumptions of the association of the policy with smoking initiation and cessation, ranging from most conservative to most optimistic. A maximum smoking reduction scenario in which all smoking would stop by the end of 2022 was evaluated. RESULTSIn the baseline scenario, an estimated 13.2 million smoking-attributable deaths would have occurred from 2012 to 2100. Under a maximum smoking-reduction scenario, 5.5 million of these deaths would be averted. Implementation of graphic health warnings from 2022 to 2100 would be associated with 539 000 (range, 275 000-794 000) smoking-attributable deaths averted and 7.9 million (range, 4.0-11.6 million) life-years gained, representing less than 10% of the 5.5 million estimated smoking-attributable deaths averted and 81.8 million life-years gained in the maximum smoking-reduction scenario. Implementation from 2012 to 2100 would be associated with 33.2% (range, 32.9%-33.5%) more deaths averted (718 000; range, 365 000 to 1.1 million) and 42.7% (range, 42.3%-43.1%) more life-years gained (11.2 million; range, 5.7-16.6 million) compared with implementation in 2022. CONCLUSIONS AND RELEVANCEThis decision analytical model estimated that FDA cigarette graphic health warnings, if implemented in 2022, would be associated with public health benefits.The model also estimated that more smoking-attributable deaths would have been averted if the policy had been implemented in 2012. Industry litigation and delays to implementing tobacco regulations may have been harmful for public health.

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Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review

Cited by 97 publications

References 49 publications

Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies

Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100

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